Healthcare when you move abroad: insurance, public systems and seeing a doctor

What residence visas ask of your health insurance, how insurers treat pre-existing conditions, when you can join the public system in eight popular countries, how to get a doctor, and what happens to Medicare, provincial cover and the NHS when you leave.

Most residence visas make you buy private health insurance first. Many public systems let you join later: in some countries as soon as you hold a residence permit, in others after a waiting period, and in some only if you work. Plan for the gap in between. Your home cover also changes when you leave. Medicare mostly stops paying, provincial plans end, and the NHS is for UK residents.

This guide covers the general rules. It does not compare or recommend insurers. Read each policy’s wording yourself, and check the rules for your own route.

What your visa asks of your health insurance

Most visas for retirees, remote workers and people of independent means ask for private health insurance. Work permits often don’t, because employees usually join the local social security system. Each route’s rule is in the requirements list on its country page. The rules fall into a few patterns.

Two warnings apply to almost every route:

• Travel insurance often fails. Spain rejects it outright. For France’s long-stay visitor visa, consulates usually refuse a standard EUR 30,000 Schengen travel policy.
• The policy must last. Most routes want cover for the whole permit, and you show it again when you renew.

Use the visa route finder to see which routes fit you, then open each country page for its insurance rule.

How insurers treat pre-existing conditions

A pre-existing condition is a health problem you had before your cover started. Each policy defines it, so read the definition first. Insurers deal with these conditions in four main ways. One policy can use more than one.

• Waiting periods. The policy covers the condition, but only after a set time. Ireland regulates these for its local market. The Health Insurance Authority sets maximums for new customers: 5 years for a pre-existing condition, 26 weeks for an illness that starts after you join, and 52 weeks for maternity claims. There is no waiting period for accidents and injuries. Ireland defines a pre-existing condition as one whose signs or symptoms existed in the 6 months before you joined.
• Exclusions. The policy names a condition it will not pay for, either for a time or for good.
• Full medical underwriting. You answer health questions when you apply. The insurer then decides what to cover and lists any exclusions in your documents before you pay.
• Moratorium underwriting. You don’t give your full history up front. Instead, the policy excludes conditions you had symptoms of, or treatment for, during a set period before you joined. The exclusion can lift after a set time without symptoms or treatment. These periods differ between policies, so find them in the wording.

Some rules come up again and again in complaints to the UK’s Financial Ombudsman Service:

• Acute versus chronic. Private medical insurance usually covers acute conditions, not chronic ones. The Ombudsman expects an insurer to show that a condition is chronic before it refuses a claim on that ground.
• Undiagnosed symptoms. The Ombudsman usually takes the view that minor, general symptoms before the policy started should not, on their own, rule out a claim. It looks at how serious the symptoms were, whether you were having tests or had been referred to a consultant, and whether you could have expected to claim.
• Honest answers. Under UK law, you must take reasonable care not to misrepresent anything to an insurer. In a dispute, the Ombudsman looks at the exact questions you were asked and your medical records. Other countries have their own rules, so read the questions slowly and answer what they ask.

Ireland’s own market works differently. Insurers there must sell to anyone who is ordinarily resident, whatever their age or health, but waiting periods apply. If you are 35 or older, buy within your first nine months in Ireland. Otherwise a lifetime community rating loading of 2% for each year over 34 is added to the price, up to 70%.

Public schemes can exclude conditions too. Mexico’s voluntary IMSS scheme is one example, described below.

Questions to ask before you buy:

1. How does the policy define a pre-existing condition, and which underwriting method does it use?
2. Which of my conditions are excluded, and for how long? Can I have that in writing before I pay?
3. Does the policy meet my visa’s rule? Check the deductible, co-payments, waiting periods, coverage limit and where the insurer is authorised.
4. Does it cover the medicines I take now?
5. My records are in another language or from another country. How should I answer the health questions?

If you are unsure, an insurance broker or adviser who works in your destination can explain the options. YourMoveMap does not rank insurers.

When you can join the public system

Rules differ a lot between countries. This table gives the main condition for people who do not work locally. Employees usually join through their job.

Spain

The convenio especial gives access to the national health system with no co-payments or waiting periods. It covers primary care, specialist care and hospital care. You must have no other route to public cover. You sign up with your region’s health service. A year on the padrón is the clock to watch, so register as soon as you have an address. Our Spain guide has more.

Portugal

You get a national health service user number (número de utente) at a health centre. For the service to cover your costs, your record needs your ID, your Portuguese tax number (NIF), your full address in Portugal and a valid residence permit. Register at the health centre for the area where you live. Our Portugal guide covers the NIF.

Italy

Holders of permits outside the compulsory categories, such as elective residence, must either insure themselves privately or register voluntarily with the SSN. A court in Milan has asked the Constitutional Court to review the EUR 2,000 minimum for elective residence holders, so check the current position. Registration lets you choose a family doctor from your ASL’s list.

France

Under PUMa, people from outside the EEA and Switzerland need a residence permit or an equivalent document. Some groups skip the 3-month wait, but not most new arrivals. Until then, your private policy is your cover.

Ireland

If you are ordinarily resident, you have either full eligibility, with a medical card, or limited eligibility without one. A medical card gives free GP visits, public hospital care and some other services. Without a medical card or a GP visit card, you pay for GP visits and prescriptions. A non-EU national’s dependants may need to show their own eligibility.

Mexico

The IMSS family health insurance (Seguro de Salud para la Familia) is open all year. Cover starts on the first day of the month after you join, and you pay the year in advance.

• Health questionnaire. Each person fills in a medical questionnaire and may be examined.
• Conditions that bar you. The regulation lists pre-existing conditions that rule out enrolment. Examples include malignant tumours, late complications of diabetes, chronic liver disease, chronic kidney failure, heart failure, and chronic lung disease with respiratory failure.
• Waiting periods. Some treatments are not covered at first: 6 months for a benign breast tumour, 10 months for childbirth, 1 year for a list of operations such as hernia surgery, and 2 years for orthopaedic surgery.
• Not covered. Cosmetic surgery, glasses, contact lenses and hearing aids, among others.
• Undeclared conditions. If a listed condition you did not declare appears in the first year, the IMSS can end your cover and charge you for the care.

Ask the IMSS which documents a foreign resident needs. Our Mexico guide covers the visas.

Costa Rica and Thailand

For Costa Rica, check the CCSS rule with the immigration authority (DGME) or the CCSS when you apply. Our Costa Rica guide has the residence routes. For Thailand, the visa sets your insurance rule. See our Thailand guide.

The Netherlands

The Netherlands is a different model. Everyone who lives or works there must take out Dutch health insurance within 4 months of arriving, even with a foreign policy. Cover then runs from the day you arrived. Take it out later and you are not covered for the months before. You must also register with your municipality.

Getting a doctor: GP registration and referrals

In most public systems, a family doctor (GP) is the way in. Register early, because the first appointment can take time.

• Spain. You get an individual health card and use your local health centre. Specialist care follows once primary care has done what it can, so your GP refers you.
• Portugal. Health centres provide family medicine and nursing. Register at the one for your area with your residence permit, NIF and address.
• Italy. Once registered with the SSN, you choose a family doctor (medico di medicina generale) from the ASL’s list.
• France. Everyone over 16 should declare a médecin traitant, a regular doctor, to the health insurance fund. If you see other doctors without a referral, you get less back. You can see a gynaecologist, an eye doctor and a few others directly once you have declared a médecin traitant. The same applies to a psychiatrist if you are under 26.
• Ireland. Your GP refers you to a hospital outpatient clinic to see a consultant. If you go to an emergency department without a GP referral letter, you pay a EUR 100 charge, unless you have a medical card or another exemption applies.

If you rely on a private policy, ask how it handles referrals. Some insurers want a GP referral or pre-approval before they pay for specialist care.

What happens to your home cover when you leave

US: Medicare and Marketplace plans

• Medicare rarely pays abroad. Original Medicare usually doesn’t cover care outside the US. There are narrow exceptions, such as some foreign hospital stays and care on a cruise ship near a US port. Medicare drug plans don’t cover drugs you buy abroad.
• Free Part A has no penalty. If you get Part A for free, there is no Part A penalty for enrolling late.
• Part B is a decision. If you don’t take Part B when you are first eligible, the late enrollment penalty adds 10% to the standard premium for each full 12 months you could have had it. You pay it for as long as you have Part B. Medicare’s enrolment booklet says people abroad who already get Social Security can usually apply only in the General Enrollment Period, from 1 January to 31 March, and may pay the penalty. One group avoids it: US citizens over 65 who are not eligible for Social Security and lived abroad when they turned 65. They can enrol without a penalty in the month they move back to the US.
• Coming back. Moving to the US from a foreign country can open a Special Enrollment Period for Marketplace plans. Marketplace plans must cover pre-existing conditions. They cannot refuse you or charge you more for them.

Ask Social Security or Medicare how the Part B rules apply to you before you drop or skip it.

Canada: provincial health cover

Each province sets its own residence rules. Tell your plan before you go.

• Ontario. You can keep OHIP while outside Canada for more than 7 months in a 12-month period, for up to 2 years, if Ontario stays your primary home. You must also have been in Ontario at least 153 days in each of the two 12-month periods before you leave. Paid care abroad is limited. For example, OHIP pays up to CAD 400 a day for the most intensive emergency inpatient care. Ask ServiceOntario how a permanent move affects you.
• British Columbia. Tell Health Insurance BC before a permanent move. For a move outside Canada, MSP cover ends at the end of the month you leave. If you come back, you wait the rest of that month plus two months before cover restarts. A temporary extended absence of up to 24 months is possible once in 5 years.
• Québec. You must be present in Québec 183 days or more a year to stay eligible. Tell the RAMQ before any trip or stay that would break that rule.

BC’s own guidance warns that most travel policies won’t cover a pre-existing condition outside the province unless you mention it when you buy.

UK: the NHS and the S1

• The NHS is residence-based. If you move abroad for good, you generally lose automatic free NHS treatment. Tell your GP practice so that you and your family are removed from its register.
• The S1 for state pensioners. If you get a UK State Pension and live in an EU country, Iceland, Liechtenstein, Norway or Switzerland, you and your dependants may get an S1. It gives you state healthcare in that country, paid for by the UK. You can apply up to 90 days before you move, through NHSBSA Overseas Healthcare Services. You cannot get one if you also get a state pension from the country you live in.
• Visits home. Since 1 January 2024, S1 holders living in those countries can use the NHS on visits to England on the same basis as UK residents. Scotland, Wales and Northern Ireland set their own rules.
• Ireland. A UK citizen who is ordinarily resident in Ireland and gets a UK social security pension may qualify for an Irish medical card.

Outside those countries, there is no S1. Plan on local or private cover.

What catches people out

• The gap after you arrive. Spain’s convenio especial needs a year of residence. France’s PUMa needs more than 3 months. Your private policy must cover the time in between.
• Ireland’s nine-month window. If you are 35 or older and buy health insurance after your first nine months there, you pay a loading for up to 10 years.
• Medicare Part B. Skipping it can mean a penalty for life, and Medicare still doesn’t pay for care abroad.
• BC cover ends fast. For a move outside Canada, it ends at the end of the month you leave.
• Undeclared conditions. A missed answer on a health form can lead to a refused claim or cancelled cover, in private policies and in Mexico’s IMSS scheme alike.
• A local pension blocks the S1. UK pensioners who also draw a state pension where they live cannot get an S1.

What to do next

1. Pick your route. The visa route finder shows the routes open to you. Each country page lists the route’s insurance rule.
2. Read the policy before the visa appointment. Check it against the rule word for word.
3. Plan your timeline. Add the date you can join the public system to Your Move, and price the private cover you need until then.
4. Check your home cover. Call Medicare or Social Security, your provincial plan, or NHSBSA before you leave.

This is general information, not legal, tax, medical or immigration advice. Health rules and fees change. Confirm them with your destination’s health ministry, the consulate handling your visa, your home health plan, or a licensed insurance adviser before you act.